Cirrhosis is a worldwide global health problem affecting up to 1% of the population and the major risk factor for progression to hepatocellular carcinoma (HCC), one of the most frequent and deadliest solid organ tumors. Although several etiological factors contribute to the development of cirrhosis, hepatitis C, fatty liver and alcohol abuse are the most common causes. Cirrhosis is characterized by an advanced stage of liver fibrosis. Currently, although liver transplantation represents a cornerstone in the management of cirrhosis, its application is limited by stringent selection criteria, high costs and donor graft shortage.
Liver injury can also be induced by accumulation of drugs. Drug-induced liver injury (DILI) includes injury caused by medicinal herbs, plants, and nutritional supplements as well as a number of drugs. Drug-induced injury mechanisms may include covalent binding of the drug to cellular proteins resulting in immune injury, inhibition of cell pathways, blockage of cellular transport pumps, induction of apoptosis, and interference with mitochondrial function, etc. Overdoses with acetaminophen (Tylenol) leading to liver toxic effects have been reported as leading cause of acute liver failure in the US and the UK. The FDA proposed to limit the hepatotoxicity of acetaminophen by reducing its therapeutic index and minimizing the combinational therapy.